1986 1987
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1986-1987. Mini Pathria Michael Zlatkin Richard (Rick) G Stiles. Mini Pathria. Middle-aged male Hx of recent knee trauma. Case 1. Middle-aged male Hx of recent knee trauma. Radiographs. Sagittal. Coronal. Axial. Thigh. Differential diagnosis. Neurofibromatosis

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1986 1987

  • Mini Pathria

  • Michael Zlatkin

  • Richard (Rick) G Stiles

Mini pathria
Mini Pathria

  • Middle-aged male

  • Hx of recent knee trauma

Case 1
Case 1

  • Middle-aged male

  • Hx of recent knee trauma

Differential diagnosis
Differential diagnosis

  • Neurofibromatosis

  • Melorheostosis with soft tissue component


  • Further history obtained

    • Skin nodules

    • Neurofibromas on cranial CT 7 years previously (not acoustic neuroma)

Case 2
Case 2

  • Middle-aged female with thigh mass

Follow up

  • Mass biopsied, benign plexiform neurofibroma

  • Patient developed hip pain


  • Plexiform neurofibroma at biopsy

  • No evidence of malignancy

Case 3
Case 3

  • 40 year old male with slowly growing painless mass

Plexiform neurofibroma1
Plexiform neurofibroma

  • Specific finding for NF1 (peripheral form)

  • 5% of patients with NF1

  • Approximately 5-10% degenerate to neurosarcoma

courtesy of Mark Murphey, AFIP


  • Localized

  • Diffuse

  • Plexiform

    • Well-defined

    • Bag of worms

    • Infiltrating

Elephantiasis neurofibromatosa
Elephantiasis neurofibromatosa

  • Diffuse form of plexiform neurofibroma

  • Overgrowth of epidermal and subcutaneous tissue

  • Wrinkled and pendulous appearance

Michael b zlatkin and alfredo arraut nmsi
Michael B. Zlatkin and Alfredo Arraut NMSI

  • 27 year old male involved in a motor vehicle accident


  • Subscapularis tendon is avulsed with bone from the lesser tuberosity

  • Humeral avulsion of the anterior band of the glenohumeral ligament (HAGL)

  • Middle glenohumeral ligament and possibly the superior glenohumral ligament may be avulsed as well

  • Possible reverse Hill-Sachs lesion

Subscap rupture and hagl bhagl
Subscap Rupture and HAGL (BHAGL)

  • Rupture of the subscapularis tendon uncommon but can be seen in younger patients injured by forced external rotation or extension of a partially abducted arm

  • Tears occur near insertion on the lesser tub. May occur at sup margin, where tendon may be weakened by degeneration

  • Avulsion fracture of the lesser tuberosity may occur, and is displaced medially and inferiorly

  • Subscapularis avulsions are also associated with injury to the anterior capsule and glenohumeral ligaments (HAGL)

  • When the AIGHL avulses a fragment of bone from the humerus, the lesion is known as a bony HAGL, or BHAGL

  • ? With MGHL and SGHL torn = Super BHAGL

Michael b zlatkin and alfredo arraut nmsi1
Michael B. Zlatkin and Alfredo Arraut NMSI

  • 17 year old male with bony growth on the dorsum of hand


  • Bone prominence on the dorsum of the hand between the trapezoid, capitate, and bases of the 2nd and 3rd metacarpals

  • Associated with base of 3rd metacarpal, but no marrow continuity with it

  • Sclerosis and cystic change at junction with 3rd metacarpal base

Carpal boss
Carpal Boss

  • Bone protuberance on dorsum of the hand

  • Degenerative osteophyte or os styloideum

  • Located between trapezoid, capitate, and base of 2nd and 3rd metacarpals

  • Most often fused to a metacarpal base, but rarely (2%) can be completely isolated

  • Symptoms caused by degeneration, formation of ganglion or bursa, or snapping of an extensor tendon moving over it

Carpal boss1
Carpal Boss

  • Can be demonstrated on lateral radiograph with hand flexed and supinated 30-40 degrees; best seen with mild ulnar deviation

  • Alternatively can image with CT or MR

  • MR can demonstrate marrow edema in the carpal boss and surrounding soft tissue changes

Carpal boss companion case
Carpal Boss – Companion Case

Carpal boss fused to base of third metacarpal with edema in overlying soft tissues

Carpal boss companion case1
Carpal Boss - Companion Case

Carpal boss fused to third metacarpal with fracture at its base

Carpal boss companion case2
Carpal Boss – Companion Case

Surface rendering of carpal boss with fracture at its base

Michael b zlatkin and alfredo arraut nmsi2
Michael B. Zlatkin and Alfredo Arraut NMSI

  • 33 year old professional hockey player with pain in the flank after practice

Findings flank after practice

  • Partial thickness tear of the internal oblique muscle belly proximally, with surrounding edema and hematoma

  • Fluid tracking between internal and external obliques

  • Feathery pattern of edema at the more distal aspect of the internal oblique

Side strain
Side Strain flank after practice

  • Uncommon sporting injury presenting with pain and tenderness over anterolateral and posterolateral lower ribcage

  • Associated with cricket, golf, and ice hockey – eccentric contraction of trunk muscles

  • Partial or complete tear of lateral abdominal wall musculature (internal oblique > external oblique > transversus abdominis)

  • May also see avulsion at the muscular origins from the lower ribs

  • Recovery takes 6-10 weeks. Full recovery is the norm